The shock of the real: Psychoanalysis, modernity, survival

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: Clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare

Reduced GABA-B/GIRK-mediated regulation of the VTA following a single exposure to cocaine

In this paper, Arora and colleagues expand on their previous work on GIRK channels in the ventral tegmental area (VTA) presenting evidence that a single exposure to cocaine reduces inhibitory GABAergic transmission to dopamine (DA) neurons in the ventral tegmental area. Mice receiving i.p. injections of cocaine saw a short lived (1-5 days) decrease in GABAb mediated G-protein coupled inwardly-rectifying potassium (GIRK) currents in DA neurons in the VTA. This decrease parallels an NMDA-mediated increase in the frequency of glutamatergic neurotransmission. Chronic cocaine injections had no additional effects beyond those seen with single injections. Though they found no change in mRNA levels for GABAb receptors, GIRK channels, or RGS-2 (a G-protein regulator), immunoelectron microscopy indicated a decrease in levels of GIRK channels in the plasma membrane of the dendrites of VTA DA neurons. The cocaine-mediated decrease in GIRK currents was abolished in the presence of D2/3R antagonist sulpiride, but not in the presence of D1/5 antagonist SCH23390, indicating a link between D2/3 receptor activation and GIRK activity. Interestingly, the addition of quinpirole, a D2/3 agonist, elicited similar GIRK currents, though they were smaller than those mediated by GABAb receptors. Similarly, acute injections of cocaine significantly diminished quinpirole-evoked currents

Dropout from Randomized, Controlled Treatments for Depression

Poster Division: Arts, Humanities and Social Sciences: 3rd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)PURPOSE: Premature treatment termination, also known as "dropout", is a ubiquitous problem in the field of mental health. There is an extensive literature investigating this phenomenon in clinical contexts, including large-scale epidemiological studies (e.g., Wang, 2007) and those conducted in community mental health clinics and private practice (e.g., Mueller & Pekarik, 2000). Estimates of dropout rate in these studies vary widely (26 – 66%; Bados, Balaguer, & Saldana, 2007). Dropout is understudied in the burgeoning field of randomized controlled trials (RCTs) of psychotherapy, even though it has implications for study design, funding, and data analysis (Lane, 2008). Additionally, dropout from RCTs may be easier to define than in clinical contexts, where doing so can be difficult (Reis & Brown, 1999), suggesting possible differences in observed rates. As such, psychotherapy researchers may benefit from an estimate of expected dropout rate specifically derived from RCTs, and from identification of study features that may influence this rate. Meta-analytic techniques provide a useful way of providing an estimate of dropout rate, and of investigating potential predictors of dropout. This study focuses on treatments for major depression, one of the most extensively studied mental health issues. Information about dropout rate was collected for each individual psychotherapy treatment arm (treatment-level) and across the study (study-level) in a collection of RCTs for major depression. Study and treatment characteristics were identified as potential predictors of dropout on the basis of the existing dropout literature, and for theoretical reasons; these included therapy type, treatment duration (both intended and observed), therapist experience, mean age and diversity of the sample, and observed effect of treatment on depressive symptoms. RESEARCH METHODS: Studies were identified using a publicly available database for RCTs of major depression (psychotherapyrcts.org; see Cuijpers, van Straten, Warmerdam, and Andersson, 2008, for details on database creation). Inclusion criteria were: a) individual therapy, b) outpatient setting, c) formal diagnosis of major depression or post partum depression, d) published in English, and e) adequate information for determining dropout rate for psychotherapy condition. Forty-six studies were included in the final dataset, representing 2802 patients. These studies included 69 separate psychotherapy treatment conditions, with an average of 1.5 conditions per study. Overall study sizes ranged from 20 to 681 (mean = 112.1, SD = 114), with individual treatments ranging from 10 to 228 subjects (mean = 40.6, SD = 39.9). The most commonly examined therapy was cognitive-behavioral (CBT). Dropout rates and all predictor variables were rated by a primary coder, with a subset of the sample (11 studies) rated by another coder for comparison purposes. Intra-class correlation coefficients for predictor variables and dropout rates were high (> .9), suggesting very good reliability. However, not all predictor variables were available for all conditions. FINDINGS: Heterogeneity analyses were conducted for both treatment and study-level dropout rates, to determine the degree of variability in dropout rates attributable to real differences (versus measurement error) and to inform analytic efforts. There was significant heterogeneity in dropout estimates, with approximately 72% of variability in the treatment-level dropout rate, and 80% in the study-level rate being attributable to meaningful differences. Heterogeneity also differed on the basis of treatment type; however, therapy types were not equally represented, ranging from 3 to 36 conditions. Due to high heterogeneity in dropout rates, a random effects model was used in all subsequent analyses, to incorporate treatment variability into pooled estimates (Schulze, 2004). The estimated dropout rate at the treatment level was 17%, with a slightly higher 19% estimate at the study level. None of the proposed study- and treatment-level predictors significantly predicted dropout rate. Intended duration predicted dropout at a trend level (p = .09), such that longer studies tended to have higher dropout rates. However, in analyses controlling for intended duration, none of the treatment characteristics predicted dropout. Moderator analyses were not conducted due to concerns about inflated risk of Type I error in the sample (Hedges & Pigott, 2003). IMPLICATIONS: The estimated dropout rate from psychotherapy conditions in individual outpatient RCTs for major depression is 17%, with study level dropout rate slightly higher at 19%. Estimates of dropout may be more or less variable based on treatment type, though this may be an artifact of unequal representation of all treatment types in this sample. None of the selected treatment characteristics predicted dropout rate significantly; however, this may have been due to the high level of heterogeneity in the sample, and incomplete information about predictors. The observed dropout rates in this RCT context appear lower than those genrally reported in strictly clinical samples, although this was not a formal comparison, and there is significant true variability in these estimates (0% - 50% in this sample). This study is restricted to a common type of psychotherapy RCT, and may not generalize to other disorders or RCT formats. However, continued efforts to expand on this research may enhance researchers’ ability to make informed judgments about likely dropout rates in all manner of psychotherapy RCTs.A five-year embargo was granted for this item

Asymmetric binary covering codes

An asymmetric binary covering code of length n and radius R is a subset C of the n-cube Q_n such that every vector x in Q_n can be obtained from some vector c in C by changing at most R 1's of c to 0's, where R is as small as possible. K^+(n,R) is defined as the smallest size of such a code. We show K^+(n,R) is of order 2^n/n^R for constant R, using an asymmetric sphere-covering bound and probabilistic methods. We show K^+(n,n-R')=R'+1 for constant coradius R' iff n>=R'(R'+1)/2. These two results are extended to near-constant R and R', respectively. Various bounds on K^+ are given in terms of the total number of 0's or 1's in a minimal code. The dimension of a minimal asymmetric linear binary code ([n,R]^+ code) is determined to be min(0,n-R). We conclude by discussing open problems and techniques to compute explicit values for K^+, giving a table of best known bounds.Comment: 16 page

Gulf War Syndrome: A role for organophosphate induced plasticity of locus coeruleus neurons

Gulf War syndrome is a chronic multi-symptom illness that has affected about a quarter of the deployed veterans of the 1991 Gulf War. Exposure to prolonged low-level organophosphate insecticides and other toxic chemicals is now thought to be responsible. Chlorpyrifos was one commonly used insecticide. The metabolite of chlorpyrifos, chlorpyrifos oxon, is a potent irreversible inhibitor of acetylcholinesterase, much like the nerve agent Sarin. To date, the target brain region(s) most susceptible to the neuroactive effects of chlorpyrifos oxon have yet to be identified. To address this we tested ability of chlorpyrifos oxon to influence neuronal excitability and induce lasting changes in the locus coeruleus, a brain region implicated in anxiety, substance use, attention and emotional response to stress. Here we used an ex vivo rodent model to identify a dramatic effect of chlorpyrifos oxon on locus coeruleus noradrenergic neuronal activity. Prolonged exposure to chlorpyrifos oxon caused acute inhibition and a lasting rebound excitatory state expressed after days of exposure and subsequent withdrawal. Our findings indicate that the locus coeruleus is a brain region vulnerable to chlorpyrifos oxon-induced neuroplastic changes possibly leading to the neurological symptoms affecting veterans of the Gulf War